A letter to the Minister for Health

2nd September 2015

Dear Minister Varadkar,

I am writing to you with grave concern regarding the HSE services to manage children and young people with severe jaw disproportion.  I myself am a young person with severe jaw disproportion currently under the care of the orthodontic and oral & maxillofacial team from St. James’s Hospital, Dublin 8.

Two and a half years ago I began my treatment to correct an underbite which would involve a total of 18 months pre operation with orthodontics, corrective double jaw surgery involving a Le Fort 1 advancement to 50% of the defect and a mandibular setback of 50% and finishing with 6 months post operation with orthodontics. As part of my pre-operative treatment I was also required to undergo extraction of all four of my wisdom teeth under sedation.

It was to my delight on March 11th that I was informed by my consultant oral and maxillofacial surgeon, Professor Leo Stassen, I would be ready for surgery after having undergone my wisdom tooth extraction 10 months previously and after having my orthodontics in place for 2 years and 1 month. Plans were quickly put in place for a surgical planning meeting on May 6th with the hope of receiving my corrective jaw surgery in July of 2015.

It is with great frustration that I am informing you I have not yet received my corrective double jaw surgery. Since my planning meeting on May 6th 2015 I have struggled to contact members of the oral & maxillofacial team and have been told different reasons as to why my surgery did not go ahead as hoped as well as being told I was not on a waiting list, my surgery would not happen until August, that my surgery would not happen for another four months and now told I have been told that it will be another 6 months before I get another planning meeting which will be 2 and a half months before surgery is intended.

I am a 20 year old student of Maynooth University who has bent over backwards to facilitate this life changing operation, I have even had to change my college course to allow the surgery to take place. I have done everything in my power to ensure my surgery could take place and now I face another 8 and a half months before surgery, which again is not guaranteed and the timeframe could continue to grow in the coming months.

I have a long history of mental health issues including Borderline Personality Disorder and a history of repeated self-harm. It is with great delight that I inform you I have been free from self-harm since February 2015 after undergoing intensive outpatient Dialectical Behavioural Therapy for 6 months. However despite my current remission from self-harming and symptoms associated with BPD and depression the stress of not only having an underbite but also the constant delay of surgery it is beginning to take its toll on my mental health. I am currently in the process of arranging additional support from my community mental health team here in Celbridge to help support me through this difficult time. This surgery is a life changing operation  which will not only change how I eat and how I look but it too will allow me to live my life, it will change how I feel about myself and it too will allow me to move on and have a life. Simple things like getting up in the morning or brushing my teeth are made all the harder with this defect and it cannot continue.

Currently there is no option for me to have the surgery I need due to the lack of oral & maxillofacial surgeons and a lack of theatre capacity all of which can be changed with adequate resources. With this lack of organised care and poorly resourced service treatment is not being provided to patients with the highest need for treatment based on health and psychosocial factors. The HSE orthodontic Eligibility Guidelines were structured in such a manner wo prioritise service for the most disadvantaged children and young people, but we (patients and service providers) are facing a situation where the service completely fails these children and young people. The current situation is not only unsafe but it is unfair to all those involved, both patients and clinicians.

I am writing to you today urging you to make a difference to the lives of children and young people affected by severe jaw disproportion. Help give us our lives back by providing the resources needed to provide us with this life changing operation.

Yours Sincerely,

Siobhán Brady
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